HomeMy WebLinkAboutMortgage_NelsonFarm.i Re�ised IA51
Piling Fae SI.00
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CERTIFICATE OF MORTGAGE� O ONTRAC INDEBTEDNESS
TO BE�FILED�IN PERSON OR BY MAIL IN DUPLICATE EAC � R OWNER WITH THE COUNTY A
QN WHICH THE PROPER7'1'95 LOCA'FED) BE'fWEEN MARCH 1 AND MAY_ 1�LUSIVE /� /�
_ (§-�I.1 12-1 THROUGH 6-1.1-12•8) � //� ////I
�_ � QUALIFICATIONS� ON BACK••• V� V/
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STATE OF INDIANA
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COUNTY, ss:
I, (We) rr i � v r�
IFULL \A\IEI
certify thal I, (1Ve) was/were leg 1 resident(s) of the State of Indiana and owner(s) of real property on March 1, 19 � and that thia
statement is made for the purpose of obtaining a deduction' from that real property ]ceated in Taxing District (City, Town, Township)
- fi(%U.V1YI1llL(Y Described to wit
Legal Description/or Key Number. �� �' ��S ` "� �`^ �"- -� 6XJ—I�-�—
Name on property tax records if different from above?
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Are you the sole legal or equitable owner of the real estate?� Yes No
If no, what is your exact share of interest in it?
Assessed value oC real estate as of March 1, current year
Amount of.Mortgage or Contract Indebtedness unpaid as of March 1, current year S���i��
c�'1 `S �— 59b 7
MortgaPe or� co � - County Recorder's Office, Record IQo. �_— Page
Name and re cmtract seller
Do you know i&t�e�e is.4nl�gnee or bona fide owner or holder of the mortgage or rnntrac[? Yes
U�. � � 1
what is the�� ap" �m"e" a"nd
;v)vi[,c! �
No If yes,
Does the owner of the above described real property own real property in any other County in the State ot Indiana?
Yes No If pes, what County and Tasing District? � 60� � � �vJ ��
Has this deduction been requested on that property for the current year? Yes No ' ��/\ .D `
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Amount Allowed
COUNTY BOARD OF
ACTION
APPROVED IN AMOUNT OF S
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RENSARKS � bd7 �
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OF BOARD
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`� 'See Fa�Statement Penalty Below *�
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10 �ER'S FUIL \AhfE)
tYI�� �/ IPERSOS AUTHORIZED BY DULY' E%ECVI'ED PoWEft OF ATICIR\EY)
\ n �J�N IFULL RFSIOEFCE ADDRFSS OF OWNER — MUST BE CIVE\)
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� �p P IAD�RESS OF AUTHORIZEO PER50\)